Upazila Health Complex Research Articles

Seroepidemiological study of visceral leishmaniasis and cattle as a possible reservoir host at Trishal Upazila in Bangladesh

To study the effect of months, seasons, age and sex on visceral leishmaniasis (VL) in human, data were collected during March 2010 through February 2011 from the register book of Upazila Health Complex (UHC) of Trishal, which is an endemic region for VL in the Mymensingh district. Besides, 70 blood samples were collected from suspected VL human patients to compare microscopy with rK39 immunochromatographic strip test. Additionally, 50 cattle blood samples were also collected from houses with active or recently-treated VL patients to determine the possible animal reservoir of VL through rK39 strip test. Of the suspected VL patients in the UHC registered book, 43.8% were seropositive. The percentages of seropositive cases were higher in September (73.3%), November (67.2%) and August (65.5%) than in May (18.5%), June (27.5%) and March (36.7%). The rainy season (58.4%) and the winter season (50.6%) showed higher seropositive than the summer (30.7%) season which was significant (p? 0.001). Hospital cases of VL were significantly (p?0.05) higher in 3-14 years (49.3%) and 15-45 years (43.5%) than in children <3 years (32.1%) and adults aged >45 years (33.6%) people. The estimated sensitivity of rK39 strip test and microscopic examination were 100% and 58.8%, respectively and the specificity were 72% and 100%, respectively. Only two cattle blood samples were found positive to rK39 strip test. Our present study indicates that rK39 strip test is superior to the diagnosis of VL compared with parasitological confirmation by direct microscopy of the peripheral blood. Further works are needed to focus on molecular approaches for diagnosis and epidemiological study of VL, sand flies investigation and to confirm the cattle as animal reservoir for VL transmission. DOI: http://dx.doi.org/10.3329/jbau.v10i1.12097 J. Bangladesh Agril. Univ. 10(1): 79–86, 2012

Availability and Rational Use of Drugs in Primary Healthcare Facilities Following the National Drug Policy of 1982: Is Bangladesh on Right Track?

In Bangladesh, the National Drug Policy (NDP) 1982 was instrumental in improving the supply of essential drugs of quality at an affordable price, especially in the early years. However, over time, evidence showed that the situation deteriorated in terms of both availability of essential drugs and their rational use. The study examined the current status of the outcome of the NDP objectives in terms of the availability and rational use of drugs in the primary healthcare (PHC) facilities in Bangladesh, including affordability by consumers. The study covered a random sample (n=30) of rural Upazila Health Complexes (UHCs) and a convenient sample (n=20) of urban clinics (UCs) in the Dhaka metropolitan area. Observations on prescribing and dispensing practices were made, and exit-interviews with patients and their attendants, and a mini-market survey were conducted to collect data on the core drug-use indicators of the World Health Organization from the health facilities. The findings revealed that the availability of essential drugs for common illnesses was poor, varying from 6% in the UHCs to 15% in the UCs. The number of drugs dispensed out of the total number of drugs prescribed was higher in the UHCs (76%) than in the UCs (44%). The dispensed drugs were not labelled properly, although >70% of patients/care-givers (n=1,496) reported to have understood the dosage schedule. The copy of the list of essential drugs was available in 55% and 47% of the UCs and UHCs respectively, with around two-thirds of the drugs being prescribed from the list. Polypharmacy was higher in the UCs (46%) than in the UHCs (33%). An antibiotic was prescribed in 44% of encounters (n=1,496), more frequently for fever (36-40%) and common cold (26-34%) than for lower respiratory tract infection, including pneumonia (10-20%). The prices of key essential drugs differed widely by brands (500% or more), seriously compromising the affordability of the poor people. Thus, the availability and rational use of drugs and the affordability of the poor people have remained to be achieved in Bangladesh even 27 years after approving the much-acclaimed NDP 1982.

Seasonal Variation in Spread, Morbidity and Mortality of Malaria in an Endemic Area of Bangladesh

A retrospective study was conducted in Cox’s Bazar district of Bangladesh collecting all the records of malaria cases from the UHCs (Upazila Health Complex) and district hospital during January 2008 to December 2011. The records of temperature, rainfall and humidity of the corresponding months were collected from the Department of Meteorology, Bangladesh. Humidity and rain fall showed significant association between incidences of all three types of malaria. Linear regression models were consistent in reporting the association. Pearson correlation matrix between weather parameters and malaria during January 2008 – December 2011 showed temporal trends in malaria occurrence.

Causes for Hospitalizations at Upazila Health Complexes in Bangladesh

Morbidity and mortality data are important for planning and implementing healthcare strategies of a country. To understand the major causes for hospitalizations in rural Bangladesh, demographic and clinical data were collected from the hospital-records of five government-run rural health facilities (upazila health complexes) situated at different geographical regions of the country from January 1997 to December 2001. During this period, 75,598 hospital admissions in total were recorded, of which 54% were for male, and 46% were for female. Of all the admissions, diarrhoeal disease was the leading cause for hospitalization (25.1%), followed by injuries (17.7%), respiratory tract diseases (12.6%), diseases of the gastrointestinal tract (10.5%), obstetric and gynaecological causes (8.5%), and febrile illnesses (6.7%). A considerable proportion (8.3%) of the hospitalized patients remained undiagnosed. Despite the limitations of hospital-based data, this paper gives a reasonable insight of the important causes for hospitalizations in upazila health complexes that may guide the policy-makers in strengthening and prioritizing the healthcare needs at the upazila level in Bangladesh.

Hospital burden of road traffic injury: Major concern in primary and secondary level hospitals in Bangladesh

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact.

Public-sector Maternal Health Programmes and Services for Rural Bangladesh

Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care in the home. However, these plans have been too meagre, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator-increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of caesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. A wide variation exists in the availability of comprehensive EOC facilities in the public sector among the six divisions of the country. Rajshahi division has more facilities than the WHO 1996 standard (1 comprehensive EOC for 500,000 people) whereas Chittagong and Sylhet divisions have only 64% of their need for comprehensive EOC facilities. The WHO 2005 recommendation (1 comprehensive EOC for 3500 births) suggests that there is a need for nearly five times the existing national number of comprehensive EOC facilities. Based on the WHO standard 2005, it is estimated that 9% of existing doctors and 40% of nurses/midwives were needed just for maternal healthcare in both comprehensive EOC and basic EOC facilities in 2007. While the inability to train and retain skilled professionals in rural areas is the major problem in implementation, the bifurcation of the MoHFW (Health Services and Family Planning wings) has led to duplication in management and staff for service-delivery, inefficiencies as a result of these duplications, and difficulties of coordination at all levels. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation.

Burn injury: economic and social impact on a family

To assess the burden of burn injury in primary and secondary hospitals in Bangladesh, and how these costs are reflected as social and economic burdens in the community. Cross-sectional study. A direct method was adopted to estimate the cost of burn injury, which involved interviewing patients or their attendants. Patient discharge records from 16 district hospitals and 45 Upazila (lower political units) health complexes were used as the main data sources in this study. Discharge records for December 2000 were reviewed for all types (injury and non-injury) of hospital admissions, and discharge records for January to December 2000 were reviewed for injury admissions. Hospital emergency departments' records for December 2000 were reviewed to study emergency injury cases. Patient interviews were conducted between February and March 2001 in selected primary and secondary hospitals in Bangladesh. Seven hundred and ninety-one burn patients were admitted in 2000, which constituted 2% of total injury admissions. Hospital records of all types of admission in December 2000 revealed that burn patients represented 1% of the total admissions. The duration of hospital stay was significantly longer for patients with burn injury compared with patients with other injuries or illnesses. The longest hospital stay due to burn injury was 17.34 days, found for children aged 1-4 years. The average patient cost for burn injury was higher than that for other injuries and illnesses. Burn injuries were associated with a longer hospital stay compared with other injuries and illnesses. The management costs of burn injury, even using very incomplete data, were found to be very high in Bangladesh. To reduce this economic burden on families, an effective burn prevention programme should be developed.

Health service resources as determinants of infant death in rural Bangladesh: An empirical study

Using empirical data collected from a rural area of Bangladesh, this paper examines the relative importance of availability of health care resources on infant death. Following many health care studies, this paper hypothesizes that the likelihood of infant death is a function of accessibility to different types of health facilities and personnel. Both univariate and multivariate analyses of data indicate that the distance to a qualified physician of Western medicine exerts significant influence on infant deaths. Other variables considered are distance to Upazila Health Complex (UHC), Family Welfare Center (FWC), and non-qualified doctors.

Assessment of the livelihood status of the fish farmers in some selected areas of Bagmara upazilla under Rajshahi district

The present investigation was carried out to assess the livelihood status of the fish farmers in Hamirkutsha and Kamarbari Unions of Bagmara upazilla under Rajshahi district during June to December 2006. Data were collected through the use of well structured questionnaire. Fifty farmers were included in this study who were directly involved in fish farming. Average pond size was 0.13 ha with single (64%) and multiple ownerships (36%). Most of the fishers were belonged to the age category of 31 to 40 years and average education level of 9.86 years of schooling, represented by 94% Muslims and 6% Hindus. About 54% of the farmers have tinshed house while 26, 14 and 6% of the farmers have half-building, building and kacha house, respectively. Average annual incomes of majority of fish farmers were above Tk. 75,000 per annum and 62% of the farmers used semi-pucca sanitary, 28% used pucca sanitary while only 10% used katcha sanitary. About 62% of the farmers had electricity facilities while 38% did not have and 88% of the farmers used own tube-well, while 12% of the farmers used neighbor's tube-well. Forty six percent of the farmers received health service from village doctor or kobiraj, 18% have access to upazila health complex, 14% went to district hospital, 20% consulted with MBBS doctor and 2% of the farmers do not take any treatment due to lack of money. Lack of scientific knowledge, multiple ownerships and lack of capital for fish culture were the major constraints. Keywords: Constraints; Fish farmers; Health service; Livelihood status DOI: 10.3329/jbau.v6i2.4836 J. Bangladesh Agril. Univ. 6(2): 367-374, 2008

Dermatological Patients at the Outdoor of an Upazila Health Complex

In outdoor of Adamdighi Upazila Health & Family Welfare Complex of Bogra district, the attendance of patients suffering from skin and venereal diseases were observed. Out of total 1,54,843 patients, 23,820 patients were suffering from various forms of dermatological diseases. The percentage of patients suffering from skin and venereal diseases were 15.34 %. Female patients were 13,667 in number (57.38%) and male patients were 10,153 in number (42.62%). Male, female ratio is 1.35:1. Most of the patients were suffering from dermatological diseases attending outdoor of the said health complex belong to 14 years and above age group (67.53%). It was observed that though previously most of the rural people neglected their skin diseases, but now a day, a good number of patients of the rural areas are conscious about their skin conditions and attend outdoor of health and family welfare complex. doi: 10.3329/taj.v17i2.3453 TAJ 2004; 17(2): 93-94

Pattern of Antibiotics Use at the Primary Health Care Level of Bangladesh: Survey Report-1

Although Bangladesh has made substantial progress in drug manufacturing since the introduction of its National Drug Policy (NDP) in 1982, irrational use of drugs, inappropriate prescribing, inadequate access to essential drugs and unjustified self medication are a few of a range of problems that are affecting the total health care system seriously. Taking this in view, a survey project has been designed to conduct nationwide to explore the pattern of antibiotics use at the primary health care level in Bangladesh using carefully constructed questionnaires containing questions covering both antibiotic prescription habit of the physicians and patients’ response to antibiotic use. In the first phase of this effort, 20 Upazila Health Complexes and the Union Health Centres thereunder each of Dhaka and Chittagong division were randomly surveyed. From physician survey it was evident that 55.57% of the doctors prescribe antibiotics in suspected infection while only 33.46% of them prescribe antibiotics in confirmed cases. 40.22% of doctors prescribe antibiotics in cold and fever before any diagnostic test. Moreover, 37.31% of doctors prescribe antibiotics for pleasing the patients whereas 62.44% denied such undue influence. Doctors seldom receive feedback of completion of course of antibiotic therapy by patients. Cephalosporin was found to be the most (26.9%) preferred antibiotic in case of empirical therapy. On the other hand, it was evident from patient survey that cold, fever and acute respiratory infection (ARI) were prevalent (39.78%) causes that brought the patients to physician. 60.1 % of the patients reported that they get essential antibiotics from hospital free of cost while 24.5% of them complained that they do not get antibiotics from hospital. 34.76% of the patients reported that they complete the course of antibiotic therapy by buying antibiotics from the market whereas 56.14% of them do not buy the full course and stop taking medicine (53.46%) as soon as symptoms subside. The results of the present survey indicate that antibiotics are widely and inappropriately used without following standard guidelines or based on any rationality. This is an alarming situation, which should be properly taken care of by the relevant authority to save the people from growing antibiotic resistance. Key words: Bangladesh; Rational use; Antibiotics; Primary health care. DOI: 10.3329/sjps.v2i1.5809Stamford Journal of Pharmaceutical Sciences Vol.2(1) 2009: 1-7